“It is not enough to adopt laws,” China’s WHO representative Bernhard Schwartlaender wrote in state media in May. “They must also be properly and rigorously enforced.”

According to the WHO report, released Monday, China’s estimated traffic-related death rate of 18.8 per 100,000 people was in line with the 18.5 average for middle-income countries but higher than the 9.3 seen in high-income nations.

Death rates remain comparatively high in China because of inadequate rescue systems and poor treatment, according to a study by Chinese researchers published in April by medical journal The Lancet.

More than one in four who died on China’s roads were pedestrians, the WHO report said, citing statistics from China’s ministry of public security, and the vast majority of fatalities — 72 percent — were men.

Road injuries are the third leading cause of years of life lost to premature death in China, ranking above any individual form of cancer, according to the Global Burden of Disease Study, a global research programme.